Left ventricular function in isolated rheumatic mitral stenosis in children

A total of 18 patients with pure rheumatic mitral stenosis between the ages of eight and 14 years (average 11.8 years) were studied. Left ventricular angiograms in the right anterior oblique view were obtained in each. Moderate to severe pulmonary arterial hypertension was present in all but one. The mean left ventricular end-systolic volume index was 25.4 +/- 8.5 ml/m2; it was increased in five patients. The mean left ventricular end-diastolic volume index was 64 +/- 13.5 ml/m2. It was normal in all except one patient, in whom it was increased to 91 ml/m2. The left ventricular stroke volume index, 39.6 +/- 8.8 ml/m2, was within the normal range. The left ventricular stroke volume index, 39.6 +/- 8.8 ml/m2, was within the normal range. The mean left ventricular ejection fraction was 0.61 +/- 0.09 ml, with a range of 0.44-0.72. The mean left ventricular ejection fraction was lower than normal (P less than 0.05). The ejection fraction was low in five of the 18 patients. Four of the five patients with an ejection fraction below 0.60 had severe pulmonary arterial hypertension. There was no correlation between the ejection fraction and left atrial pressure or the mitral valve area. Segmental contraction analysis in the five patients with a low ejection fraction showed global hypokinesia in four and segmental hypokinesia, involving predominantly the posterobasal segment, in one patient. Our study suggests that even children with pure mitral stenosis may have left ventricular dysfunction in the absence of active carditis.